Friday, May 20, 2005

The Pig and the Watch

People are different -- different looks, different perspectives, different personalities. I may be accused of seeing things from a skewed perspective, but it seems that the differences between people is laid out in stark fashion in the medical world. Are there two more disparate types of people than psychiatrists and cardiac surgeons? Internists and anesthesiologists? I know that I am making some generalizations, but clearly there are some personality types that gravitate towards certain types of medical practice.

Which leads me to orthopedists (tongue firmly in cheek). Every doc that reads this knows about the great brain sucking machine that is attached at the completion of surgical internship to (nearly) all of the residents heading into orthopedic surgery. Out goes all of the standard medical knowledge about how to care for patients --- drug dosages, treatment of diabetes, how to evaluate a preop patient, etc. Room must be made for the names of total joint prostheses, types of fractures, and the phone numbers of the ortho reps. Simplify, simplify, simplify!

Which brings me to my favorite (true) orthopedic story. As an intern on the ortho service, my job was to stay out of the OR and care for all of the patients --- give Coumadin and pain meds, arrange PT and rehab, do the admits and discharges. One morning, a postop total hip patient was doing poorly. Diaphoretic, mildly hypotensive, chest pain, increasing oxygen needs; she basically was going down the tubes. Being the good intern, I ordered tests!! Bloodwork, ABGs, a chest x-ray, and EKG....which showed big time ST changes.

On my way to phone the ICU and cardiologist, I run into the surgeon who had operated on her. He was the chief of the department, a real big wig and by all accounts a great surgeon. "Dr. Bones, I think Mrs. Brokenbody is having a massive MI! Here, look at her EKG." And Dr. Bones returned with one of the best lines I have ever heard: "Son, showing that to me is like showing a watch to a pig."

A truer statement has never been made!